National bowel cancer audit programme (NBOCAP)

Colorectal (large bowel) cancer is the most common cancer in non-smokers and second most common cause of death from cancer in England and Wales. Each year over 30,000 new cases are diagnosed, and bowel cancer is registered as the underlying cause of death in half of this number.

Survival beyond 5 years in bowel cancer is usually equivalent to a cure, and survival rates in the UK have been rising steadily over the past three decades. However, significant international differences suggest that there is considerable scope for improvement.

In the United Kingdom 50 per cent of patients with bowel cancer survive 5 years which is lower than Western Europe (over 50 per cent survival) and America (60 per cent survival). Differences are mainly due to UK patients presenting to hospital with late stage, more advanced disease. The reasons for this are not yet clear but could be due to poorer access to diagnostic investigations and lifestyle.

The ACPGBI developed a bowel cancer data set which was based upon regional audits previously held in Wales, Trent, Wessex and Lothian in the 1990s. The database program was developed by the Centre for Clinical Oncology, Clatterbridge and then transferred to NCASP.

Aims of the audit

The main purposes of the audit are to measure the process of care and clinical outcomes, enabling comparisons between hospitals and bringing about improvements where necessary. This comparison is complicated because of the variation in the mix of patients (casemix) between one hospital and another. Currently the main factors to consider in casemix include age, social deprivation, extent of development of the cancer (stage), operative urgency (whether an emergency or not) and whether the patient also has another illness (comorbidity).

their casemix i.e. the age, stage of disease and fitness of their patients

processes of care i.e. quality of investigations, access to specialist care, time to treatment

clinical outcomes i.e. post-operative mortality, length of hospital stay after operation, frequency of stomas and serious postoperative complications, local recurrence of the cancer after rectal cancer surgery and survival from cancer

All of these can be compared with national averages.

Hospitals that consistently achieve above average results will be identified and by adopting their methods in other centres, the quality of care and survival rates for bowel cancer patients across the United Kingdom will be improved.

The audit assesses achievement against many of the NICE guidelines and is a potentially powerful way of monitoring which hospitals are observing the national guidance for bowel cancer care.

Organisation of the Audit

The National Bowel Cancer Audit is managed by the National Clinical Audit Support Programme, within The Information Centre for health and social care, for the Association of Coloproctology of Great Britain and Ireland.